New findings suggest that long-term use of proton pump inhibitors is linked with an increased risk of gastric cancer in patients infected with Helicobacter pylori – even after the infection has been treated.
H. pylori eradication therapy has been shown to reduce the risk of gastric cancer but not remove it completely. The risk is higher among users of proton pump inhibitors, so researchers at Queen Mary Hospital, Hong Kong, looked at how H pylori affects this risk.
They used a large health database in Hong Kong to identify adults who had received an outpatient prescription of the proton pump inhibitor clarithromycin between 2003 and 2012. Looking at the 63,397 eligible participants, about a quarter of 1% developed gastric cancer in the following seven or so years.
In the analysis, proton pump inhibitor use was associated with a more than doubled gastric cancer risk. Another class of drugs that suppress gastric acid secretion, histamine-2 receptor antagonists, was not linked to gastric cancer.
The longer proton pump inhibitors were used, the more the risk of developing stomach cancer rose – to five-fold after more than a year, to more than six-fold after two or more years, and to more than eight-fold after three years or longer.
"The risk increased with duration of proton pump inhibitor use," the authors reported in the journal Gut yesterday (1 November).
They conclude: "Long-term use of proton pump inhibitors was still associated with an increased gastric cancer risk in subjects even after H. pylori eradication therapy."
They suggest that: "Physicians should exercise caution when prescribing long-term proton pump inhibitors to H. pylori-infected individuals even after successful eradication of H. pylori."
Cheung, K. S. et al. Long term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population based study. Gut 1 November 2017 doi: 10.1136/gutjnl-2017-314605 [abstract]
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